Provider Demographics
NPI:1174261200
Name:ELEVATE CONCIERGE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ELEVATE CONCIERGE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC, CLT
Authorized Official - Phone:860-942-9978
Mailing Address - Street 1:13203 OVERCUP OAK CT APT 302
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4888
Mailing Address - Country:US
Mailing Address - Phone:571-519-8826
Mailing Address - Fax:571-388-3161
Practice Address - Street 1:13203 OVERCUP OAK CT APT 302
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4888
Practice Address - Country:US
Practice Address - Phone:571-519-8826
Practice Address - Fax:571-388-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy